Haemophilus spp., an emerging multidrug-resistant sexually transmitted pathogen.

OBJECTIVES: To describe the characteristics of patients with a positive urethral sample for Haemophilus spp. MATERIAL AND METHODS: We performed a retrospective study from January 2018 to July 2019 at the Bordeaux university hospital (France) of all urethral samples positive for Haemophilus spp. RESULTS: Haemophilus spp. was isolated in 10 urethral samples from nine patients. The mean age was 33.8 years. Most patients reported having unprotected sex. Haemophilus parainfluenzae was isolated in nine samples, and Haemophilus influenzae in one sample. Antibiotic susceptibility tests were performed in five samples; Haemophilus spp. was always resistant to amoxicillin and tetracycline. One patient had persistent symptoms after treatment for a multidrug-resistant Haemophilus parainfluenzae strain. CONCLUSION: Haemophilus spp. is a rare pathogen of urethritis. Its responsibility should be considered in case of persistent symptoms. The emergence of multidrug-resistant Haemophilus spp. is becoming problematic.

High prevalence of Mycoplasma genitalium infection and macrolide resistance in patients enrolled in HIV pre-exposure prophylaxis program.

OBJECTIVES: Limited data on Mycoplasma genitalium infection has been reported among PrEP users. The aim of this study was to estimate the prevalence and macrolide resistance of M. genitalium infection among enrollees in a French PrEP program. PATIENTS AND METHODS: M. genitalium infection screening was systematically and prospectively proposed to patients of the Bordeaux PrEP program (between January 2016 and February 2017). Macrolide resistance was evaluated in M. genitalium-positive patients. RESULTS: Among 89 clients, M. genitalium infection prevalence was 10% (mainly asymptomatic) with a high rate of macrolide resistance (58%). CONCLUSIONS: Because of a high level of macrolide resistance, a systematic search for M. genitalium macrolide resistance associated-mutations may be recommended in PrEP users before initiating the antibiotic therapy.

Clinical and biological features of enteroviral meningitis among adults and children and factors associated with severity and length of stay.

BACKGROUND: Enterovirus (EV) meningitis is the most common form of meningitis. Clinical and biological manifestations may be non-specific, leading to prolonged and costly investigations. OBJECTIVES: To determine the different aspects of EV meningitis and the variables associated with length of stay (LOS) in hospital independently of patients' age. STUDY DESIGN: Single center retrospective study of all EV PCR positive CSF samples during 3.5 years in Bordeaux University Hospital, France. RESULTS: 172 patients were included. 65 were under 3 years old and 49 over 18 years old. 10% of patients had severe forms of the disease. 47 patients (27.3%) had normal CSF count and in 63 patients (36.6%) polynuclear cells predominated in CSF. Procalcitonin, Hoens' score or PCR in stool samples appeared as good markers for enteroviral diagnosis. Time elapsed before PCR results was associated with LOS (p = .002) and should help in limiting investigations in case of aseptic meningitis. CONCLUSION: Rapid availability of EV PCR reduces LOS for patients and contributes to diminish unnecessary procedures and further tests.

Comparison of the Antimicrobial Properties of Silver Impregnated Vascular Grafts with and without Triclosan.

OBJECTIVES: The aim was to compare the antimicrobial efficacy of the silver impregnated collagen coated polyester vascular graft (IGS) with an identical graft combining silver and triclosan (IGSy). METHODS: This was an in vitro study. A non-antimicrobial collagen polyester vascular graft served as control (IG). The IG, IGS, and IGSy grafts were contaminated separately with inoculates of each of the following micro-organisms: Staphylococcus epidermidis (SE), methicillin resistant Staphylococcus aureus (MRSA), and Escherichia coli producing extended spectrum beta-lactamase (ESBL-EC) or Candida albicans (CA). MRSA, ESBL-EC, and CA were obtained from retrieved infected grafts. The in vitro antimicrobial efficacies of the contaminated grafts were evaluated by time to kill assays over a 24 hour period in accordance with CLSI Guideline M26-A. All assays were repeated six times. Bacterial survival numbers were obtained at 1, 4, 8, and 24 hours using a standard plate count procedure. Bactericidal activity was defined as a 3 log10 reduction factor (logRF). To calculate the overall difference in the mean log10 CFU/mL within 24 hours, a one way ANOVA with a Bonferroni correction was calculated separately for each graft. RESULTS: The IG graft showed an increase in the number of viable organisms for the four strains tested. IGSy offered better antimicrobial properties than IGS for both ESBL-EC and MRSA, since only the IGSy graft achieved > 3 logRF and fulfilled the standard criteria for bactericidal activity at 24 hours with 3.78 and 4.08 logRF, respectively. For samples inoculated with SE and CA, both antimicrobial grafts achieved 24 hour bactericidal activity with > 3 logRF. However, for CA the one-way ANOVA analysis demonstrated that the IGSy graft performed differently in terms of speed of antimicrobial action, appearing more active as early as 4 hours following inoculation (p = .007). CONCLUSION: In the in vitro conditions, the Synergy vascular graft combining silver with triclosan demonstrated better short-term antimicrobial activity than the silver graft for all micro-organisms tested.

Comparison of fasting, nasogastric suction and cimetidine in the treatment of acute pancreatitis.

88 unselected patients with acute pancreatitis entered a randomized clinical trial comparing the therapeutic efficacy of fasting alone, nasogastric suction and fasting plus cimetidine. The disease was mild to moderate in all but 3 cases, and cholelithiasis was the main etiological factor. The number of treatment failures and complications, and the clinical outcome were similar in the three groups. However, when compared to fasting alone, nasogastric suction was shown to delay the resumption of bowel activity a mean of 11 h (p less than 0.05), prolong the duration of pain a mean of 20 h (p less than 0.01), increase analgesic needs (pentazocine lactate) a mean of 64 mg (p less than 0.05), and lengthen hospital stay a mean of 2 days (p = NS). In conclusion, cimetidine has no beneficial effects in acute pancreatitis. It is suggested that fasting alone be initially used as the simpler, safer and more economical therapy. Nasogastric suction should be reserved for patients presenting with intestinal ileus, a situation that occurred in 1 out of every 8 cases in the present series.